Provider Demographics
NPI:1316513187
Name:THIEL, NICOLE ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:THIEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 N 17TH AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4283
Mailing Address - Country:US
Mailing Address - Phone:715-898-1812
Mailing Address - Fax:715-898-1815
Practice Address - Street 1:10524 GEORGE AVE
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:WI
Practice Address - Zip Code:54412-9677
Practice Address - Country:US
Practice Address - Phone:715-652-3470
Practice Address - Fax:715-898-1815
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15674--24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist